Research and Methods Core - Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

退伍军人事务部健康管理局(VA)是美国最大的综合医疗保健系统，为 每年为近50,000名新诊断出癌症的退伍军人提供服务。为所有退伍军人提供公平、高质量的护理是一项 退伍军人医疗保健使命的宗旨。我们假设有三个特殊因素--种族、贫困和乡村-- 在决定获得医疗保健，特别是远程保健方面至关重要；我们将这三个因素称为社会 远程健康的决定因素(SDTH)。大约25%的退伍军人生活在农村地区，那里可能没有 当地有足够的退伍军人事务部癌症护理设施。不幸的是，这些社区往往缺乏专门的 基于社区的癌症护理服务，使远程医疗成为减少地理、 经济和种族障碍阻碍了高质量、及时的癌症治疗。然而，人们对远程医疗如何提供服务知之甚少 对于有癌症影响的退伍军人，公平地提供高质量的护理、临床结果和护理经验。 作为一个专注于癌症护理质量和公平的全国性综合医疗保健系统，退伍军人管理局提供了 优秀的国家实验室，以检查远程保健的使用如何影响医疗服务的获取、质量和公平。我们 将能够检查针对SDTH的干预措施如何影响远程医疗的使用以及远程医疗的使用 影响质量和公平。我们将广泛传播这一信息，以帮助其他医疗保健系统 了解如何最好地将远程医疗整合到癌症护理的连续体中。使用以下原则 实施科学、远程医疗研究和癌症退伍军人创新(Thrive)将利用 促进健康公平科学的健康差距研究框架：构建新模式 提供癌症护理服务，解决SDTH问题，并履行获得优质癌症护理的承诺 退伍军人，无论通信格式如何。研究和方法的核心主要集中在健康 公平，特别是了解SDTH如何影响获得医疗服务的机会和质量。 我们的多学科团队将通过专注于肺、结直肠、前列腺和乳腺来实现Thrive的愿景 癌症与实现五个具体目标：(1)评估利益相关者对背景因素的看法 在多个层面上影响癌症远程保健的实施和维持；(2)衡量在以下方面的使用： 整个退伍军人事务部癌症护理的个人和远程医疗通信格式；(3)评估如何使用 远程保健用于癌症护理，控制远程保健的社会决定因素--特别是种族/族裔、贫困、 和乡村-与癌症护理质量有关；(4)监督选择、开发、实施 和评价10项快速周期试点研究(2/年)，在卫生公平、执行 科学和远程保健癌症护理；以及(5)制定扩大有效干预措施的可负担性，这些干预措施包括 从试点研究中确定的。

The Veterans Affairs Health Administration (VA) is the largest integrated health care system in the US, caring for nearly 50,000 veterans with newly diagnosed cancer annually. Equitable, quality care for all veterans is a tenet of the VA healthcare mission. We hypothesize that three particular factors – race, poverty and rurality – are critical in determining access to healthcare, especially telehealth; we refer to these 3 factors as the social determinants of telehealth (SDTH). Approximately 25% of veterans live in rural areas where there may not be adequate local VA cancer care facilities. Unfortunately, these same communities often lack specialized community-based cancer care services as well, making telehealth a necessary option to reduce geographic, economic and racial barriers to quality, timely cancer care. However, little is known about how telehealth delivery for veterans with cancer impacts equitable delivery of quality care, clinical outcomes and experiences of care. As a national integrated health care system focused on quality and equity of cancer care, VA provides an outstanding national laboratory to examine how use of telehealth affects access, quality and equity of care. We will be able to examine how interventions targeting SDTH affect the use of telehealth and how use of telehealth affects quality and equity. We will disseminate this information broadly to help other health care systems understand how best to integrate telehealth into the continuum of cancer care. Using principles of implementation science, Telehealth Research and Innovation for Veterans with Cancer (THRIVE) will leverage Health Disparities Research Framework (HDRF) to advance the science of health equity: building a new model of cancer care delivery addressing SDTH and fulfilling the promise of access to excellent cancer care for veterans regardless of communication format. The Research and Methods Core primarily focuses on health equity, particularly understanding how SDTH impact access to and quality of care. Our multidisciplinary team will achieve THRIVE’s vision by focusing on lung, colorectal, prostate and breast cancers and accomplishing five specific aims: (1) Assess stakeholders’ perspectives of contextual factors impacting cancer telehealth implementation and sustainment at multiple levels; (2) Measure the use of in- person and telehealth communication formats for cancer care throughout VA; (3) Evaluate how the use of telehealth for cancer care, controlling for social determinants of telehealth – specifically race/ethnicity, poverty, and rurality – are associated with cancer care quality; (4) Oversee the selection, development, implementation and evaluation of 10 rapid-cycle pilot studies (2/year) at the intersection of health equity, implementation science and telehealth cancer care; and (5) Frame the affordability of scaling up effective interventions that are identified from the pilot studies.